Effectiveness of screening and monitoring tests for diabetic retinopathy – a systematic review

Hutchinson, Allen; McIntosh, Aileen; Peters, J. M.; O’Keeffe, Colin; Khunti, Kamlesh; Baker, Richard; Booth, Andrew

doi:10.1046/j.1464-5491.2000.00250.x

Cited by 221 publications

(173 citation statements)

References 26 publications

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“…Simulation models suggest that substantial savings, both monetary and in sight-years, are reached with an overall sensitivity of 60%, as the cost-benefit curves drop steeply for lower sensitivities and plateau for better performances [65]. Since average sensitivity and specificity for trained operators and dedicated equipment range from 80 to 90% [66], available methodologies could be deployed with very good prospects of success. A recent systematic review concluded that mydriatic retinal photography, associated with direct and/or indirect ophthalmoscopy if the pictures are ungradable, remains the most reliable screening test.…”

Section: Methodsmentioning

confidence: 99%

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Diabetic retinopathy

2002

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Abstract. Easy observation of the fundus oculi makes retinopathy the most frequently reported chronic complication of diabetes and, consequently, the one we know best in terms of epidemiology and natural history. Achieving near-normal levels of blood glucose and blood pressure provides empirical though powerful tools for clinicians to delay the onset and progression of diabetic retinopathy. Even when these measures have failed and retinopathy becomes sight-threatening, laser photocoagulation has proven remarkably effective. Nonetheless, retinopathy remains a leading cause of blindness and there is little evidence that diabetes-related visual loss is decreasing in industrialized countries. This may result from the mixed blessing of prolonged survival of patients who had become diabetic when metabolic control was pursued less fastidiously than today. Screening for sight-threatening retinopathy is the most cost-effective medical procedure known and should help optimise the use of diagnostic and therapeutic resources, but its widest deployment still meets with inertia and lack of interest within most health care systems. Improving clinical skills and technology, however, allow us to take a more optimistic look at the future, as pathogenesis-targeted forms of treatment are being developed and tested through appropriately powered clinical trials. [Diabetologia (2002[Diabetologia ( ) 45:1617[Diabetologia ( -1634

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Section: Methodsmentioning

confidence: 99%

“…A recent systematic review concluded that mydriatic retinal photography, associated with direct and/or indirect ophthalmoscopy if the pictures are ungradable, remains the most reliable screening test. [66]. FAG should not be used to screen.…”

Section: Methodsmentioning

confidence: 99%

Diabetic retinopathy

2002

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“…Studies comparing methodologies for diagnosis of diabetic retinopathy are lacking in dogs, but it is reasonable to assume that ophthalmoscopy alone may miss subtle lesions. Although ophthalmoscopy is accepted as the most commonly used screening tool for diabetic retinopathy in humans, fluorescein angiography and multiple field stereoscopic fundus photography are more sensitive than ophthalmoscopy alone in detecting the condition 32, 33. However, neither multiple field stereo fundus photography nor fluorescein angiography is practical to employ on a routine basis with clinical veterinary patients.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Prevalence of Hypertension, Proteinuria, and Retinopathy in Dogs with Spontaneous Diabetes Mellitus

Herring

Panciera

Werre

2014

Veterinary Internal Medicne

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BackgroundThe prevalence and progression of vascular complications of spontaneous diabetes mellitus (DM) in dogs have not been described.ObjectivesTo investigate the effects of duration of disease, as estimated by time since DM diagnosis, and glycemic control on prevalence of systemic hypertension, proteinuria, and diabetic retinopathy in dogs with spontaneous DM.AnimalsSeventeen client‐owned dogs with spontaneous DM.MethodsProspective, longitudinal observational study. Dogs with DM of less than 1 year's duration were recruited and evaluated once every 6 months for 24 months. Recorded measures included indirect BP, urine albumin, protein and creatinine concentrations, serial blood glucose and serum fructosamine concentrations, ophthalmic examination, and a standardized behavioral questionnaire.ResultsEleven dogs completed the 2‐year follow‐up period, during which the highest recorded prevalence of systolic and diastolic hypertension was 55 and 64%, respectively. Prevalence of microalbuminuria and elevated urine protein:creatinine ratio (UPC) ranged up to 73 and 55%, respectively. Prevalence of retinopathy ranged up to 20%. No significant effect of time since DM diagnosis or glycemic control was detected for any of the measures examined. Additionally, no significant associations between BP, urine albumin concentration, UPC and retinopathy were detected.Conclusions and Clinical RelevanceWith the exception of proteinuria, which was substantial in some cases, clinically deleterious diabetic vascular complications were not identified in dogs in this study.

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“…The authors concluded that mydriatic retinal photography provides the most effective screening and monitoring test for detection of sight-threatening diabetic retinopathy. 6 In general, the sensitivity and specificity levels were higher in studies where retinal photography was the method of choice.…”

Section: Introductionmentioning

confidence: 96%

“…The Diabetes Control and Complications Trial highlighted the importance in insulin-dependent diabetes mellitus (IDDM) of good diabetic control in reducing the risk of progression of retinopathy. 6 Similarly, the UKPDS demonstrated that good control of both blood pressure and diabetes in type II diabetics significantly reduced the risk of microvascular end points related to diabetes including retinopathy. 7 The benefits of laser photocoagulation are well known.…”

Section: Introductionmentioning

confidence: 98%

Is screening with digital imaging using one retinal view adequate?

Herbert

Jordan

Flanagan

2003

Eye

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Purpose To compare the detection of diabetic retinopathy from digital images with slit-lamp biomicroscopy, and to determine whether British Diabetic Association (BDA) screening criteria are attained (480% sensitivity, 495% specificity, o5% technical failure). Methods Diabetics referred for screening were studied in a prospective fashion. A single 451 fundus image was obtained using the nonmydriatic digital camera. Each patient subsequently underwent slit-lamp biomicroscopy and diabetic retinopathy grading by a consultant ophthalmologist. Diabetic retinopathy and maculopathy was graded according to the Early Treatment of Diabetic Retinopathy Study. Results A total of 145 patients (288 eyes) were identified for screening. Of these, 26% of eyes had diabetic retinopathy, and eight eyes (3%) had sight-threatening diabetic retinopathy requiring treatment. The sensitivity for detection of any diabetic retinopathy was 38% and the specificity 95%. There was a 4% technical failure rate. There were 42/288 false negatives and 10/288 false positives. Of the 42 false negatives, 18 represented diabetic maculopathy, 20 represented peripheral diabetic retinopathy and four eyes had both macular and peripheral changes. Three eyes in the false-negative group (1% of total eyes) had sight-threatening retinopathy. There was good concordance between the two consultants (79% agreement on slit-lamp biomicroscopy and 84% on digital image interpretation). Conclusion The specificity value and technical failure rate compare favourably with BDA guidelines. The low sensitivity for detection of any retinopathy reflects failure to detect minimal maculopathy and retinopathy outside the 451 image. This could be improved by an additional nasal image and careful evaluation of macular images with a low threshold for slit-lamp biomicroscopy if image quality is poor.

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Effectiveness of screening and monitoring tests for diabetic retinopathy – a systematic review

Cited by 221 publications

References 26 publications

Diabetic retinopathy

Diabetic retinopathy

Longitudinal Prevalence of Hypertension, Proteinuria, and Retinopathy in Dogs with Spontaneous Diabetes Mellitus

Is screening with digital imaging using one retinal view adequate?

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